Archive for Health Care

A nursing student checking the hearing of an elementary school student

It’s nearing the end of the last week of our Farmworker Family Health Program trip in Moultrie and I can’t believe my time here is almost done. Every one here has gotten so much into their routine that the days almost seem to meld together, flowing from one task to another. In the past few mornings at the elementary school, we have been seeing the last few kids that needed to go through the stations as well as a few kids that needed to be re-screened if they didn’t pass certain tests or assessments. Wednesday morning I was doing vision screenings with another BSN student and we were testing a boy in the second grade. As we were having him read the shapes in the chart we noticed he could barely make it past the first few lines of shapes and was squinting and leaning forward; after the full assessment it was very obvious he had vision problems and would get a referral to a clinic where he would likely be getting glasses. He was right at the age where having difficulty seeing would make it more difficult for him to learn and pay attention in class and ultimately affect his overall education, but because we were able to catch this problem early, his vision will be able to be corrected. A lot of times doing so many of these screenings for hearing, vision, blood pressure, and blood glucose can seem repetitive, especially if a majority of the kids are healthy, and I sometimes lose sight of the fact that these tests can catch major problems early on for these children.

A view from the camp we worked at Wednesday night

BSN Student, Molly Murphy, providing foot care to one of the farmworkers while two Nurse Practitioner students help assess

On Tuesday night we went to the same camp as Monday night, but this time we were prepared: we knew it was going to be raining again that night so we set up everything inside the screened in building so we didn’t have the delay of relocating all of our supplies and tables inside. It was a small, compact space we were working in but everyone stayed focus and we were able to move around each other without any major collisions. On Wednesday night we were at a new camp that was slightly smaller than the previous two nights so the pace was slow going at first. This came as no surprise to us, but it of course began raining around 30 minutes into seeing the men through the stations. This camp had no coverings to go under, but luckily there was no lightening so we knew we could stay and find a way to continue working. Some of us braved it in the rain with ponchos and umbrellas and others were set up in some collapsable tents where we tried to keep as many people dry as possible. Everything out at these camps is an unexpected adventure and this night was no different.

BSN Student, Jenny Choe, providing education on high blood sugar management with the help of a translator

When we are working with the men, we have amazing translators that are with us at each station as well as with each dental hygiene student, pharmacy student, and the student nurse practitioners as they complete their physicals. However, there aren’t always enough translators to be at every spot we want them so they often have to get relocated where they are most needed at the time, which is what happened to me when I was working at the blood glucose and hemoglobin station when our translator was needed at another location. At first I was worried to be without a translator to help explain to the patient what I was going to be doing and how to explain and educate them on their results, but as I have talked about previously, this group of people here is always so willing to help anyone.We almost immediately had one of the pharmacist students come over to us and offer help translating what she could as we had other nursing students go ask others for some key Spanish phrases to tell and ask the men. Even in times of chaos everyone here is able to pull together and make sure we accomplish the goals we came out here to do. We are seeing one final group of men at a camp tonight and then finishing charting and packing up at the elementary school in the morning. As I write this we have less than 24 hours left on this trip and I hope to enjoy every minute and help everyone I can!

We spent the last two days with complete immersion into the Haitian culture. We started Saturday morning at Complexe Educatif Men Nan Men which is a multi-lingual school funded by Foundation For Peace in pursuit of teaching English, Spanish, French, and computer classes for less than $4 to the student. The students were quite curious and eager in asking questions about the American culture and our perspective of Haiti.

Christine (left) and Ektaa (right) conducting English classes.

Later in the afternoon, we set up a clinic in the schoolyard where we saw about 80 students. What was unique about this experience was that some of the students helped in translating; they were very ecstatic to practice speaking the English they have been learning for the past few months.

Nicole gathering patient history.

We attended a Haitian church service on Sunday morning at Pastor Valentin’s church. We were greeted by a very friendly community and participated in singing and dancing at the church that was led by only children. It was great to see how involved the children were in putting this event together.

Our leader, Helen, thanking the church members for a warm welcome.

Shortly after the service, we were guided by the Foundation For Peace staff to tour the local community. We took a bit of a scenic hike through many fields to a small village where church members live. They were living in quite unfortunate circumstances where a small hut would be home to at least 8 people. Despite their living conditions, the people of the community welcomed us with open arms.

Last night a little after 6:30pm we arrived at a new farm, covered head-to-toe in bug spray and ready to tackle whatever the night threw at us. Thankfully there was no rain on the radar for the night, but this camp definitely brought some new challenges and surprises; there were no coverings at the camp so we were outside with the grass coming up to our knees. Even though we were at a new location, the set up went smoothly since we have settled well into all of our roles throughout the different disciplines. I was placed at the blood glucose and hemoglobin stations where we were doing finger sticks on the men that came through. Doing the finger sticks on the farmworkers can sometimes be challenging because their fingers are often very callused making it harder to draw blood for both machines. We’ve all learned techniques from each other to make the process easy for us and the men so we don’t have to stick them again. Sometimes we have to squeeze and massage down their hands (a process some nurses have termed “milking” the arm) and holding their hands down at their side to let gravity help the blood flow. The men were able to go around and see all of the nursing stations, the nurse practitioners, physical therapy, and dental hygiene throughout the night and get the help and referrals they needed.

One of the nursing students getting a good stretch from a physical therapy student during a break!

This morning we went back to Cox Elementary School to continue our care and screening for the kids. Another one of the nursing students and I went upstairs and got ready at our station that was testing height, weight, and BMI. Working with the children at the station was pretty simple, all we had to do was weigh them and measure their height but it required a lot of charting so, like yesterday during the vision screening, we took a lot of turns charting and keeping the kids entertained who were waiting. In our room we were testing in we also had a physician from Guatemala who was sitting with the kids waiting teaching them about Zika virus. She used coloring books and pictures to explain to them what the virus is and how they can help prevent it for themselves and others. The Zika virus is becoming an increasingly difficult problem, especially here in rural South Georgia during the summer months, so teaching these kids from a young age is very crucial. Our hotel we are staying at is also very kindly serving all of us dinner tonight before we head out to our last night at a farmworker camp for the week. We head home for the weekend tomorrow afternoon but we’ll be back Sunday night to start our second week of service here!

A little after 5:30pm yesterday evening, we once again loaded everyone in the program into our 30 car caravan to go back to the camp we helped at on Monday night. I felt a lot more comfortable and confident going back now that I had a night to see how everything was run and get used to the language barrier. Set up went smoother since we knew where everything went and it thankfully wasn’t raining or muddy (yet). All of the workers at the camp very graciously served our entire group a traditional Mexican dinner. The food was delicious and it felt so nice for them to welcome us into their lives in such a kind way.

Some of the housing facilities for the camp

Last night I was assigned to the foot care station where we cleaned the mens’ feet, cut their nails, moisturized and massaged their feet, and assessed for any infections or problems to refer them to the nurse practitioners and clinic. The foot care station is often the station that a lot of us nursing students dread, but it was set off to the side of the camp where we weren’t in the center of the hustle and bustle. A big part of the station involved educating the men on proper foot care and how to protect them from pesticide exposure in the field that can accumulate in their shoes, but since we got to sit with the men in a quieter environment, we could talk with them and connect and give them a bit of much needed relaxation and pampering. Unfortunately, a few hours into being at camp the clouds moved in and it began pouring so we had to close up the foot care station since it was outside. The other people working at the station and I ended up circulating and offering help at different stations as needed and tried to make the rest of the night as productive and smooth as possible.

BSN Student, Jessica Yang, hula hooping before the kids came in!

This morning we again returned to Cox Elementary School to help continue assessments and screenings on the kids in the summer school program. I was working at the vision testing station where we used picture charts to help test their vision for distance and also a book to check for color blindness. Gabrielle, one of the other BSN students, and I were working together and had a great flow with the kids as we would switch off having one of us filling out the kids’ charts as we tested their eyes and the other person pointing at the pictures and keeping the kids in the room entertained with stickers and funny glasses. I really enjoy starting the days working with the kids; they are so much fun to work with and they bring out a funny, silly side in everyone working and make the day so much more enjoyable. Tonight we are at a new camp working with a new group of men where more help, education, and learning can happen!

Yesterday we had our first night working with the farmworkers at their camps and it was quite an operation; everyone in the program throughout all of the disciplines lined up in their cars next to our hotel for a giant caravan drive to our first farm of the week! We all arrived together through muddy roads and began unloading and setting up numerous truckloads of supplies in our finest rain gear: ponchos resembling giant plastic bags and our scrub pants tucked nicely into our rain boots.

Sun goes down, head lamps go up!

Everyone was very excited setting up and preparing to meet and work with the men here. One of my favorite parts of this program is how we have so many different medical fields working together and learning from each other. Molly, one of the other nursing students, and I got to teach a group of the pharmacy students how to use the blood sugar and hemoglobin machines and then they were able to help us throughout the night when that station got busy. Even dental hygiene students helped the student nurse practitioners identify problems in the mens’ mouth. It was really great to see all disciplines finding ways to help each other and give the men we are assessing the best help they can get. Once all of the workers started filing in, I was definitely feeling the pressure… possibly because I was assigned to the blood pressure station… but also because I was facing the reality of trying to assess and educate these men when we didn’t have a language in common. I felt confident in my technical skills in taking blood pressures but that confidence was immediately lost when I tried to introduce myself, explain what I was doing, what their results were, and education on high blood pressure management when I only spoke English and they only spoke Spanish. Thankfully, like all students do in nursing school, I figured out a way to make it work. I learned a few phrases to help build some connection and realized how important a smile and a reassuring hand on the arm can be. We also have amazing translators with us that helped with some more complicated translations and education between us and the men. At around midnight we finally had everything packed up and drove our long line of cars back to the hotel.

After what only felt like 30 minutes of sleep, we were up again today and back at Cox Elementary School in the morning. Thankfully, almost all of our supplies were still set up from yesterday so it didn’t take too much work before we got to start seeing the kids. I was at the blood pressure station, but unlike last night I also had the added bonus of handing out stickers to the kids who came through. Many of the kids were very young and could only speak a little bit of english but we still made sure to have fun! They all got excited to get their blood pressure taken by a cuff that would “give their arm a big hug” before picking out the perfect sticker. I loved being able to joke around with the kids and show them how all of the equipment worked, which for them included squeezing the air pump of the blood pressure cuff until their hand got tired and tapping on my stethoscope as soon as I placed it in my ears. All of the kids there are so sweet and I’m so glad we can come and do our part to help them the next two weeks. Tonight we are back at the same camp we were at last night to continue our care for the rest of the men. It’ll be another muddy night but I know it will be worth it!

Part of the fun of international travel is always finding reliable internet connectivity. Since my last post I have been fighting quite aggressively with the internet and my computer, but finally I overcame (which is impressive if you knew how little I understand about computers). Anyway here is what I had typed up for day three and then some extra added to it to include days four and five (so it’s crazy long):

Afternoon storms are becoming a normal part of our routine – I think that they’re the only thing that actually runs on schedule here. Those of us who need internet, for homework or more leisurely activities like Netflix viewing, are watching the clouds and lightening roll in from the open, covered area where we get internet at this hotel. It’s making things significantly cooler here, which is such a blessing. The rainy season has begun in Guatemala, which means that the entire night was filled with rain falling on the tin roof of our room and that the entire day felt sticky and hot.

This morning, as the midwives started walking into the courtyard this bubble of excitement overwhelmed the table that where we were all sitting. We wanted so badly to go and greet them, and know them, and express our appreciation for them being there. Two issues with that desire: we didn’t want to overwhelm them and none of us speak their native language. Instead we settled for the traditional “Buenas días” and a pat on the arm/kiss on the cheek as they headed to our conference area.

Rebecca Gloss and Hannah Lake-Rayburn did the teaching today. The spent the entire morning dialoguing with the midwives about high blood pressure during pregnancy, preeclampsia, symptoms of these conditions, and when women were traditionally referred out. We then broke off into small groups and taught these midwives how to take blood pressures using the BP cuffs and stethoscopes we brought down for them. It was so exciting to realize how veracious these people are to learn new skills and about new equipment that they knew would help the women that they love so much.

Not that this teaching didn’t come without challenges: the majority of our group speaks some Spanish, but that becomes completely moot when trying to communicate with the majority of the midwives because they speak a traditional Mayan language that sounds and tastes nothing like Spanish. It’s harsher sounds, stronger syllables, thicker tongues. Luckily, we had a translator there, Maria, and quite a few of the midwives also spoke both, so in the end it all worked out from that standpoint. We were also educating a couple of illiterate individuals, which made taking blood pressures difficult for them because while they could hear the sounds and understand where on the monitor they needed to note numbers, they couldn’t dictate what the number actually was – which almost defeats the purpose. Our solution? Mark on the cuff monitor which pressures indicated an emergent situation and necessitated a referral. This job requires nothing if not adaptability.

After eating lunch with the midwives, they began there journeys back home – some of which would be more than two hours – and we returned back to our rooms for a quick siesta. At 1530, we met back up with one another and took the bus into the town of Chisec. We could hear and see the storm rolling in, but we were determined to get in a little bit of walking in spite of the obvious incoming weather. We paid for our stubbornness and got caught in a small shoe shop during a torrential downpour. All of the people who were in town took cover under something and we just watched the streets quickly fill with water. Luckily, the shop keepers were extremely pleasant and allowed us to stay under cover until Oswaldo came and picked us up in the bus.

The rest of the evening was spent putting together small packages for the midwives – consisting of gloves, umbilical ties (they don’t do clamps down here), new scissors to cut the umbilical cords with, sterile blue towels, and a couple of pairs of sterile gloves. All of these new goodies will provide the midwives with a very limited supply of some of the resources that they need – but we’re trying. These packages coincide beautifully with the educational session about sepsis and neonatal infections that will be conducted tomorrow by myself and Tamara Noy.

Our teaching went well. We got to have lengthy conversations about infections and how the midwives traditionally care for their women. I think at this point we were all quickly coming to the realization that these midwives are so so so knowledgable and so passionate. It becomes much more of a dialogue and much less teaching – an exchange of treatments and options and ideas. It’s so inspiring to learn from them and to hear what they go through on a daily basis.

We got to do a home visit with one of the comadrones, which was very eye-opening. The woman we saw five months pregnant with her fifth child. Her husband, her four daughters, and she lived in a building that is roughly the size of typical dorm room with dirt floors and a large curtain splitting off some of the sleeping areas from everything else. There were three chickens living in the house with them and a large (I mean large) bin of corn in one corner. Even though it was small, and the family was obviously impoverished, everything was clean and well-cared for – and the woman had pride showing us where she lived and introducing us to her daughters (all through the interpreter mind). We also got to see the return OB visit, the midwife did Leopold’s (basically felt the belly to determine the size and position of the fetus) and then did a mini rubdown of the woman’s legs and belly and arms – kind of like a massage. It was wonderful to see a midwife in another country utilize similar tools that we do in the States.

Finally, on Thursday, Chelsea and Michelle did their teaching on postpartum hemorrhage. They used chucks and poured different amounts of fake blood on to them to have the midwives determine which needed a referral and which was okay. We also supplied the midwives with headlamps and showed them how to use them so that they could see when they were walking in the middle of the night and check for tears in poorly lit buildings. Chelsea and Michelle mimed a birth with a postpartum hemorrhage and asked the midwives what they would do throughout. It was a very successful learning day.

We then went a stood in a circle with all of the comadrones and began throwing a ball of yarn from person to person. The person with the yarn would share what they had learned or what they enjoyed most about the past three days, would keep a hold of the string, and pass the ball along. At the end, we were all connected by this string which physically exemplified the way in which we were connected by our profession and our passion for the women that we get to care for on a regular basis. I think it’s safe to say that these three days in Chisec were inspiring and uplifting on both ends and just made me so much more excited to enter this profession.

After seeing hundreds of patients this week, we spent our day off with some R&R at Moulin Sur Mer. It was a beautiful beach with clear, blue waters and soft waves. Later that evening, the Foundation For Peace organized a Creole class to help us better communicate with the patients we were seeing.

Relaxing and bonding at Moulin Sur Mer

The patient population we saw that day was quite different from those earlier in the week. They were more educated and some even spoke English. The kids were more playful and eager to ask questions. A lot of the care we provided was surrounded around patient education and prophylactic treatment.

Joya discussing adolescent growth

The day was filled with a great amount of teamwork as the Pastor of the church, Pastor Valentin, was present the whole day to keep things organized. Pastor Valentin’s sister, who is a NICU nurse in Haiti, was also present to help triage and assess vital signs.

Our amazing team for the day

We were fortunate to work on a team with many hard workers that came together to provide optimal patient outcomes!

In all seriousness, our first day was wholly a travel day. The travel adventure began at 0400 for some of us and others at the slightly more reasonable time of 0700. The day did not end until 1900, Guatemala time, which is 2100 for those of you reading on the East Coast – which roughly equates to 14-17 hours of travel, depending on who you’re talking to from our trip. We flew into Guatemala City and were ushered onto a bus by Sofia (She’ll make lots of appearance on this blog, I’m sure. She’s our fearless leader and organizer from CEDEPCA – the organization we came with) and Oswaldo (He’ll also make lots of cameos – he’s our bus driver and we all love him. PS you say his name OsValdo). We quickly learned that things didn’t really run on a schedule as what was supposed to be a four hour drive to Cobán became a six hour long trek down a well-loved road. Our hotel was lovely (see picture below), dinner was delightful (think well-seasoned eggs with onions and tomatoes with some plantains and beans), and then we all crashed.

This morning we met with the ministry of health and the nurse who’s in charge of all the midwives here, Erica (she’s also in charge of TB, but that’s a different story for a different group). We talked all about our role here, educating, and how the midwives have historically been viewed in this country. As a future midwife, it was fascinating, but I won’t bore you with all the details. I do think that it’s significant to let you know that the midwives deliver 45% of the babies born out in the community, which is an impressive percent when compared to the out-of-hospital births in the United States (according to one source, it’s roughly 1-1.5% of births). These midwives do this with limited resources and the closest hospital/back-up provider about two hours away (if they can find a car).

After our meeting we got back into the van and drove two hours to the city of Chisec. Parts of Guatemala seem so untouched, like humans have never stepped foot on the majority of its land. I keep mentally comparing it to Jurassic Park because it has the same level of lushness and similarly impressive mountains. It’s crazy to think about the Mayan people walking these mountains that felt so uncomfortable to drive along. The cities and neighborhoods themselves are obviously impoverished, but a few of us have noted that in spite of the poverty, they feel exceptionally clean and friendly in comparison to other countries we’ve visited. As we drove along the roads we could see two of the major commodities in the country – corn and coffee. The corn is essentially grown over every square inch of available land and comes right to the edge of the road with the occasional rectangular house breaking up the jungle. On the other hand, the coffee is grown in beautiful lines or concentric circles up and down the mountains. It looked like my version of heaven – caffeine and order. Chisec itself is much lower than where we stayed last night (and when we return to Cobán on Thursday, I’ll give you the scoop), and it’s hot and muggy. Imagine Florida during the dead of summer and you’ve got the weather we’re staying.

Tomorrow is the first day where we actually get to meet the midwives and all of us expressed excitement at the thought tonight during our reflection time. Don’t worry, we do this every night so I’m sure you’ll get to hear all about them at some point. Anyway, it’s almost 2100 my time (2300 Eastern), so it’s time to go tuck in bed, watch an episode of Arrow (no, I’m not kidding), and set my 0630 alarm.

Jenny Foster and Marissa Storms [me!] enjoying all the fruit and yogurt for breakfast.

The courtyard at our hotel in Cobán

Our hotel in Chisec – it’s rained like this on and off since we got here.

Our day started off bright and early where we were greeted by the Foundation For Peace staff with breakfast. Shortly after we boarded our bus to visit Elbenizer Hospital for our first patient encounter in Haiti.

This is a local hospital that sees patients outpatient of a variety of ages, has a lab, operating room, an emergency room with 1 bed, and a few about 10-15 inpatient beds.

Our team split up to work with the Haitian doctors and nurses to efficiently treat a room full of patients.This was our first day working with Creole translators and providing care which had it’s difficulties taking a history. We also were introduced to diseases that are common among Haitian populations and learned how they present and how to treat.

After enjoying another delicious Haitian meal, our evening concluded with packing and sorting supplies for our next day’s clinic.

I’m Sarah Julius, a (soon-to-be) senior BSN student. I’m one of the students that’s going on the Farmworker Family Health Program trip in Moultrie, Georgia and I’ll be blogging my way through the next two weeks of my experience here! Following three hours of belting songs in the car, we arrived yesterday to the Ellenton Clinic in Moultrie, Georgia feeling excited but unsure of what the next two weeks would bring us. After signing in, we all crowded in a room together with other undergraduate nursing students, nurse practitioner students, pharmacy students, physical therapy students, and dental hygiene students. Although we initially tried to sit with our respective disciplines to seek out familiar faces, we were soon separated into groups with a student from each division so we could start our first activity: a scavenger hunt around the city of Moultrie where we saw the elementary school we would be working at, health care centers, and the local Walmart to buy something for the Farmworkers. Not only were we able to see the Moultrie environment and understand our surroundings, we were also able to meet new people in an interdisciplinary setting and learn about how they’ll be contributing different parts to this experience. We finished the night at a local Moultrie Fine Arts Center where everyone dressed up (the first and last time we will probably see each other in clothing other than scrubs) and Center was gracious enough to host us and serve us an amazing dinner.

BSN Students making a pit stop on the road trip down to Moultrie!

Our first morning and full day started early in the morning at Cox Elementary School where we transformed the gymnasium and surrounding classrooms into a makeshift clinic. We were all so excited to get everything started and begin seeing the kids that were there! Setting everything up took a few hours so the kids had to wait before they could come in. I would watch them as they came in and got to sit and play with toys and run and jump around as they were working with physical therapy. Unfortunately, the kids were not too happy when they got to where I was sitting with two other nursing students… the dreaded blood glucose station where they had to get their fingers stuck. We tried to still keep things fun, letting them pick their bandage design and stickers, but these 4-year-olds saw right through all of our tricks. Some kids just stared at me and sat on their hands (I would have done the same thing if I was them to be fair), but there were a few brave kids that got to show off their Minion bandages and Iron Man stickers to their friends later. After seeing a few groups of kids we cleaned up and one of the nearby churches, the Church of Jesus Christ of Latter Day Saints, made everyone in the program a well-deserved lunch (consisting of a full spread of nachos, cookies, and fruit). Right now as I write this it’s a little after 3pm on the first full day; we have some downtime to relax and hangout before we leave caravan style with all of us packed in around 30 cars from the comfort of our hotel to our first farm to work with the farmworkers. It is my first time working in a setting like this and in an environment where I don’t speak the same language as my patients. I’d be lying if I said I wasn’t a little nervous, but I’m excited to see what challenges and experiences the rest of the night (and next two weeks) holds! It’s been raining all day so everything will be nice and muddy when we get there, thankfully we all brought our rain boots!